Addiction: Definition, Treatment, and Recovery
Addiction defies all logical and humanistic survival tendencies. Addict’s jobs, freedom, families, and even their lives could be lost as a consequence of addiction. Step 1 of the 12 Steps describes addiction as displaying“powerlessness” to the addiction and the consequences of the powerlessness has lead to the addict’s life becoming unmanageable. The Diagnostic and Statistical Manual of Mental Health Disorders (DSM V, 2013) defines Substance Abuse Disorder as meeting more than two of the criteria below :
• Continuing to use substances despite negative personal consequences
• Repeatedly unable to carry out major obligations at work, school, or home due to substance use
• Recurrent use of substance use in physically hazardous situations
• Continued use despite persistent or recurring social or interpersonal problems caused or made worse by substance use
• Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount
• Withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal
• Using greater amounts or using over a longer time period than intended
• Persistent desire or unsuccessful efforts to cut down or control substance use
• Spending a lot of time obtaining, using, or recovering from using substances
• Stopping or reducing important social, occupational, or recreational activities due to substance use
• Consistent use of substances despite acknowledgment of persistent or recurrent physical or psychological difficulties from using substances
• Craving or a strong desire to use substances (This is a new criterion added since the DSM-IV-TR)
Neuroscience has also been able to identify proteins located in the white matter of the brain that are correlated with an addictive personality or tendencies, further verifying the theory that addiction is often genetic and biological (vs. a behavioral choice). Most addicts have a family history of addiction and/or mental health issues (i.e. diagnosable depression, anxiety, or bipolar). Addicts’ personalities and temperaments tend to exhibit a high sensitivity to others’ temperaments or expression of feelings, a low tolerance for negative feelings, and poor communication and coping skills. A lot of these manifestations are caused by a childhood or family history of trauma, abuse, and neglect (either “real or perceived”. Neglect can also be defined as "anything less than nurturing" behavior by your parents.
While there are exceptions to the following, I have not seen or met a true “addict” who has been able to conquer his/her addiction and live a “worthwhile” life without the help of a 12-step community, an addiction treatment program, and/or some other professional (or spiritual) assistance. Some hypothesize that this is in part due to the concept behind Step 1 of the 12 Steps. If the addict is truly “powerless” to the addiction (i.e. It doesn’t matter how smart he is, how much he loves his family, how much he wants to survive and not die at the hands of his addiction, but he still can’t abstain) he needs a group of people around him to keep him accountable, help him “talk out” and identify where he’s rationalizing, denying, or minimizing his addiction, and help him slow down and restabilize when he’s riding that slippery slope that leads to relapse. Most of the aforementioned are accomplished through the 12 Steps/AA program, consulting with someone educated in addiction treatment, and/or using another accountability program. Accountability, commitment, and honesty (to yourself and others) are all key components to recovery. You should not try to do it alone. And why would you? This is a life-long challenge that will affect several aspects of your lifestyle. You should involve your friends and your loved ones.
For Those Who Love An Addict:
As I've mentioned before in my previous blog on Betrayal Trauma, addiction often involves lying, deceit, gaslighting, hurt, harm, and betrayal. It is difficult for loved ones to delineate between loving and enabling an addict. There are support groups for those who live with and love addicts called Al-Anon and CoDA (Codependents Anonymous). Similar to AA, these groups are meant to be a safe communities where attendees can share their struggles, find camaraderie and compassion, and also receive boundary-setting advice and accountability. My previous blog on Healthy Relationships touches upon the importance of boundaries. It’s a very difficult road to watch a loved one struggle with addiction. It's especially hard to realize that its totally out of your control.
If you or someone you love is struggling with addiction, please feel free to call me with any questions or concerns. There are many options and choices out there. I’m here to help.
Addiction is an extremely difficult concept to understand for those who do not experience it. “Normies”—a term addicts use to describe those who don’t struggle with addiction—have a hard time understanding why addicts can’t just “will-power” their way through sobriety. After all, addiction is so destructive and dangerous, not to mention there are legal consequences. So often I hear clients’ loved ones say, “She’s such a smart woman who has so much to live for, why won’t she just stop drinking/doing drugs?” or “If he only loved our family enough he would stop gambling/doing drugs/sexually acting out” or “Doesn’t he see how much damage his addiction is causing?” Addicts (and their families) often think that if they approach the addiction with enough “discipline” and “willpower” they can beat it. Of course, “white knuckling” through addiction by just willing yourself to not use or act on your impulses (versus authentic recovery) often leads to relapse. Relapsing can trigger more shame and detest for one’s self—things addicts already struggle with greatly—and can result in an increase in use or intensity. What the addict and his family don’t usually realize is it’s not about ones’ will power to beat the addiction, it’s about understanding and respecting the power of addiction.